Improving outcomes in cardiovascular care-time to refocus on the hidden determinants of health?

The technological and pharmacological advances in cardiovascular care have contributed to improved patient outcomes, but the burden of disease remains significant. This has recently been confirmed by the World Heart Federation (WHF), demonstrating that more than half a billion people globally are affected by cardiovascular disease.1 Moreover, global cardiovascular disease-related mortality increased from 12.1 million in 1990 to 20.5 million in 2021. Interestingly, these mortality rates declined in high income countries, compared with low- and middle-income countries that contribute to ∼80% of all cardiovascular death.